Trump's cuts to grants that help Americans get ACA coverage are latest strategy to undermine the law

Jul 10, 2018 | 7:25 PM

President Donald Trump speaks to the media as he walks to Marine One prior to departure from the South Lawn of the White House on July 10, 2018. (Saul Loeb / AFP/Getty Images)

The Trump administration is eliminating most of the funding for grass-roots groups that help Americans get Affordable Care Act insurance and will for the first time urge the groups to promote health plans that bypass the law's consumer protections and required benefits.

The reduction - the second round of cuts that began last summer - will shrink the federal money devoted to the groups, known as navigators, from $36.8 million to $10 million for the enrollment period that starts in November.

Last August, federal health officials announced that they were reducing the navigators' aid by 41 percent, from $62.5 million, and slashing by 90 percent a related budget for advertising and other outreach activities to foster ACA enrollment.

The new reduction of help for navigators, announced late Tuesday afternoon by the Centers for Medicare and Medicaid Services (CMS), fits within a pattern of moves by the administration to weaken the sweeping health-care law, which President Donald Trump has vowed to demolish. During his first year in office, Trump pressed the Republican-led Congress to repeal much of the 2010 law, one of President Barack Obama's signature domestic achievements.

Since Congress was unable to pass such legislation, Trump and his aides have been taking steps to weaken the law through administrative maneuvers. The cuts to grass-roots groups around the country were announced three days after health officials revealed that, because of a pending lawsuit, they were suspending a program created by the law to even out the burden on health insurers whose customers are especially unhealthy or sick.

The president last fall issued an executive order to try to make it easier for individuals and small businesses to buy health plans that cost less than ACA coverage because they cover fewer services and bypass rules intended to protect people from previous practices in which insurers charged higher prices to women, older people and those with preexisting medical conditions.

Since then, the Labor Department has issued a rule to broaden the use of one such kind of insurance, called "association health plans." The Department of Health and Human Services is finishing another rule that will lengthen the duration allowed for short-term insurance plans that were originally intended as a brief bridge for people between jobs.

Groups that apply for navigator grants will now be expected to encourage clients to buy those two types of insurance. Until now, the grants have been used only to help people choose and buy ACA health plans or to help steer people with low incomes toward Medicaid.

In its announcement, the CMS reprised arguments it made last year that navigators, which operate with the annual grants in the 34 states that rely on the ACA's federal insurance exchange, have been ineffective and are less important than they once were: "As the exchange has grown in visibility and become more familiar to Americans seeking health insurance, the need for federally funded navigators has diminished."

The announcement also said navigators helped enroll fewer than 1 percent of the nearly 12 million Americans who signed up for ACA coverage for 2018 - a figure that navigators contend understates their accomplishments. The announcement said consumers should rely more on the private sector to buy coverage, including insurance agents and brokers as well as insurers themselves.

For the past five years, when insurance has been available through ACA marketplaces for people who do not have access to affordable health benefits through a job, federal health officials have started every spring working with navigator groups on plans for the coming enrollment season. Tuesday's announcement and details in an accompanying grant notice were the first information the CMS has provided this year.

"I have not heard any of this," said Catherine Edwards, executive director of the Missouri Association of Area Agencies on Aging, which has spread navigator money to groups across that state and took a 62 percent cut in funding last year. "They're just strangling the program. . . . They couldn't kill the program in Congress, so they are cutting the money."

As for the priority given to applicants that help spread the word about non-ACA health plans, Edwards said: "It's inappropriate. This gets into the business of insurance products, and that is the bailiwick of agents and brokers. It is not the bailiwick of community organizations." that are expressively forbidden under the navigator program's rules to recommend any particular health plans.

In listing examples of the kinds of groups eligible to apply for the money that remains, the CMS did not mention the grass-roots nonprofits that have done most of this work. It listed "chambers of commerce, small businesses, trade associations, and faith-based organizations."

Sen. Ron Wyden, Ore., the ranking Democrat on the Senate Finance Committee, said in a statement that urging navigators to promote non-ACA plans amounts to "federally funded fraud: paying groups to sell unsuspecting Americans on junk plans that allow insurance companies to deny care on a whim and charge whatever they want is nothing but a scam."